This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 26 November 2009

Nice Headline about Nurses Daily Mail

No doubt whatsoever that there were issues with Nursing care at Basildon.

With the kind of trained nurse to patient ratios that British nurses are working with I am not surprised. I wouldn't expect a nurse with superpowers to do any better. I have worked in 3 countries as a nurse over a period of 13 years. Let me remind you of something. Nurses in the UK are working with trained nurse to patient ratios that wouldn't be legal in a 3rd world hellhole like Haiti. Not only that, but they have a lot less back up than say a nurse in Canada or Australia would have.

I once asked asked a super american nurse friend of mine if she would take on 15 acute patients. She is a bedside nurse, very well respected and has won multiple awards. She would tell you no way would she take on more than 6 acute patients with no back up because it would be nothing but a total fail, no matter how hard she worked. She would refuse to work in a hospital like mine that can assign a nurse anywhere from 10 to 30 and upwards patients. This statement came from a nurse friend of mine in the North East USA who won an award for most compassionate nurse at her Magnet Hospital. Google Magnet.

No one in their right mind would expect a nurse to be able to function in the conditions that NHS nurses are working in right now. Whether they are angels or devils, they are going to fall flat on their faces and fail. Therefore we can conclude, once again, that most commentators on the daily mail are lunatics.

I'll let my readers take this apart in the comments section. I don't have the energy right now.

What have I learned from this article? Journalists still don't understand that most of these "nurses" are not actually nurses.

The daily mail is such an extreme example of Yellow Journalism that it would even shock William Randolph Hearst with it's vileness.

I also take offense to the fact that they are depicting nurses as lazy. If you are an RN in acute care you WILL be working many 12-14 + hour shifts without taking any kind of a break. The health care assistants and clinical support people running around in their nurses uniforms don't go through this but Nurses often do.

12-14 hours without a break or a drink, on your feet while the support assistants stop for tea. It's not like they can help you keep up with the nurse stuff anyway. Remember that most of the readers commenting on this daily fail article probably work 8-9 hour days and get an hour lunch break. Now that is lazy.

Dear Daily Fail,

Interesting piece. I will never so much as have a minute free in shift to screw around with mattresses. If the hospital will provide more staff nurses on shift with me to handle all the drugs, treatments, assessments, orders and accountability then I will happily clean the mattresses. Happily. God I would love a shift spent cleaning and I am very much a degree nurse.

There is a massive difference between a nurse not cleaning a mattress because she is alone and cannot drop the ball on the drugs and the treatments for 30 seconds and a nurse that just doesn't want to do it. The former is a lot more likely and the latter is rare. Cleaning mattresses rather than being the only RN for multiple acutely ill patients sounds rather pleasant to 99.9% of us. You see, we would consider an 8 hour workday without life and death responsibility a vacation day with a paycheck. Especially if it was an 8 hour workday without life and death responsibility and a lunch break. Even if it was only a 10 minute lunch break.

This is what we think of people who work outside of health care and un-registered people who work in health care. You are all having permanent vacation days with paychecks. A nurse I used to work with who left health care to work as a teaching assistant explained it to me that way and so have many others.

An RN can be working at a pace you cannot begin to imagine sometimes for 14 hours straight with no break and still only get through the top 1% of what needs to be done that shift. That means that even if he is working at that kind of pace most of his patients will languish and not get fed or basic care simply down to the fact that the nurse is so outnumbered by people who need help.

I am starting to realise that it won't actually matter if I stop for 5 minutes to get a drink during my 12 hour shift. It won't change a goddamn thing.Patients are going to suffer whether I do or don't.

Get a safe trained nurse to patient ratio campaign going on or shut the fuck up.

Sincerely Yours,MMN.

PS- no one believes that you care about patients. A sustained media campaign to expose the reality of the situation and staff our hospitals with trained nurses would result in a level of care that would have made the idea of starving neglected patients on filthy wards a distant memory. It would also be cost effective to increase your ratios of trained nurses. But that wouldn't give you sensationalist yellow journalism headlines now would it?

By the way does anyone know of a casualty unit anywhere in the NHS where the actual nurses could afford to be lazy for even 10 seconds and then get out of there without being blamed for someone's death?

29 comments:

Great post, there are no words to describe the foulness of that paper. It makes me nervous knowing that so many people read the utter cack they put out on a daily basis, and they wonder why society is going to shit.

Be nervous Emily. When the visitors are screaming and raging at the staff nurse on duty you can hear the daily mail speaking through them. It's like they haven't thought independently about the situation at all.

They ignore the fact that there is one nurse taking care of their mum as well as 12-20 other people. They ignore the fact that this same nurse has two other patients pre arrest whilst their own mum is medically stable. They see the nurse at the station calling for and ordering equipment and meds from pharmacy for the critical patient and they accuse her of ignoring mum to hang out at the nurses station and gossip.

You can hear the daily mail influence every time they open their mouths.

We had one guy start accusing one of the nurses of being a too clever to care and declared her to lazy to be bothered looking after his dad. He had asked her to bring him a pillow right when she was smack in the middle of a cardiac arrest.

Within the next few years a nurse will be stabbed or beaten into a coma on the job by one of these freaks who thinks their loved ones are languishing and starving because we are intentionally neglecting them. Mark my words.

I think about this every day when I go into work and still cannot get all my patients fed.

Think about it. If I am the only RN and someone needs a narcotic pain pill can I just walk away from an LVFer going downhill to chase orders and pharmacy and hunt down another RN to give that narcotic pain pill? Can I be away from the LVFer that long? Of course not.

But the family of the patient who needs to pain pill doesn't understand all that and will stand there accusing me of leaving their mum in pain out of laziness. One day soon one of them is going to lose it and target a nurse violently...violent attacks happen to nurses all the time but it's really going to escalate.

Just make sure that when you are a staff nurse that you don't make any dumb mistakes despite the fear of being accused of being to clever to care. Always try and deal with the basic care yourself but accept it when you can't and don't take any shit from people.

The bitchy HCA who was complaining about the fact that you weren't helping her bedbath WILL NOT defend you when you are getting struck off for missing a sudden deterioration in condition on one patient whilst your were off bathing another.

Some of our newer grads are making some pretty scary mistakes and omissions in their quest to prove that they are not to posh to wash.

I don't know I'm pretty much brought to tears of frustration about this. The cacophony of lies from all the UK papers is too loud.

How will the UK nurses ever be heard, how will the truth get out?

My readers comment which was perfectly polite brought up nurse patient ratios, the fact that the public think that everyone in an NHS uniform is a nurse and that things are a little different from when Flo was a nurse was of course, not printed.

I also brought up the point that I could never return to the UK and work as a nurse.

They did print a lot of comments from old bats that nursed for all of two or three years in the sixties.

I agree with you about the violence, nurses are already getting physically attacked, these articles are going to make it much worse.Keep blogging Anne.

The reason that all the research into nurse education shows that patients of degree nurses have higher survival rates is because degree nurses have additional critical thinking and analytical skills. Crucial. Crucial.

Thanks for leaving your comment over at Though Cowards Flinch. I wasn't aware of your blog but I'll certainly be making reference to it at my place.

I love the straightforward focus on a) the Daily Mail, Spectator etc know fuck all b) what counts is staff ratios, and they are wrong.

With ref to your comment at my place, I'd love to have more details on what you've sent to Iain Dale as a corrective, and what he's ignored, as I think he really does need challenging and I'd be happy to help with that. He's probably a more accessible target than, say Melanie Phillips or the Daily Mail, and it would be good to see if we could, with a bit of concerted blog coverage, get some support for a look at the realities of ward-based nursing.

I'll carry on my history of the changes to nursing from a class/gender perspective as I get chance, and would value your comments.

Thanks Anne for scaring me to death haha. I have worked before as a HCA (and a carer before that) on a Admissions unit post-A&E, you know where they go to avoid the 4hr limit. Thankfully the Nursing ratios weren't as bad there. Although at 21 I was still one of the more "experienced" HCA's, the level of common sense in some of them as well as any kind of initiative is frightening, so when the patients and relatives kicked off it was usually to do with something a HCA has missed or done to a patient. We don't have cadets in my old trust. But they did employ any kind of retard on the bank as a HCA. I've seen visitors get violent before now too, and just be plain asswipes. Patients have too been violent, one threw the bowl of a commode (positive for C-Diff) right in a nurses face. Yes, it was full up. Another kicked my friend (a HCA) in the face and cracked her jaw whilst she was trying to help a man with a bed bath. I've had a couple of swings but 2 older brothers and years of WWF wrestling moves pulled on me as a result has made me a little more resiliant and my reflexes are sharp.

My first proper placement as a Nursing student starts in 2 weeks on Acute Elderly Medical / Stroke. It's not a massive ward and I've been told it's an amazing learning environment from several facilitators at my Uni and by students in year 2. To be honest I was a little worried about starting work at a massive English inner-city hospital when all I've done for the last few years is work in a small welsh community hospital and care homes. But I'm sure I'll be okay and hopefully avoid any trouble. However my friend in Year 3 has been landed in a ward much like yours. Even as a student she's stretched and patient/nurse ratios are scary, she's doing as a 3rd year alot of the work as a HCA and afraid she will be unable to pass her competancies as the nursing staff and mentor are spread thin. She's faced abusive relatives, patients, and even had trouble from Staff such as the doctors etc. She can't wait to get out of there. Once she qualifies she's gonna go into Community nursing and perhaps see if she can do it in Canada in a few years. Good for her.

Keep challeging the mindless out there, it may not ever work but it's better than doing nothing.

General medicine is my first love. People don't understand that because it isn't the glam world of a&e and ITU but I love it when staffed properly. I don't need glam. I just want to avoid really acute complex patients and don't mind the dependent ones. They are sending "way to sick for a general ward" patients there all the time so it kind of sucks.

We are anywhere from 18-30 beds depending on when they open the other hallway. Often they have to as there are more patients than beds but they do not up the staffing when they increase your patient load by 12. Most days are 1/3 of the time we have 1 RN, sometimes we have 2. On a really lucky day we have 3 but they'll float one away usually if that is the case.

There is a stroke unit at my hospital with 15 beds. It is usually pretty nicely staffed. So are some of the surgical units. Other surgical units are appalling. Our A&E is in bad shape staffing wise I hear.

There is a 35 bed extremely acute medical ward that is very lucky to have 2 RN's on duty. Often it is one. We float there sometimes.

It varies. But all these scare stories you read in the papers, they are all coming from places that have the worst bedside RN to patient ratios.

I started a blog post (and never finished it) about the history, gender issues with nursing and why people have the attitude that they do. Feel free to take anything you need from here. Mostly I replied in Iain's comments section. Just ignored really.

Keep writing great blogs by the way Anne,i've been enjoying them loads and going back and reading old ones!

I've only just started my blog. Writing seems to come more natural to you then it does to me, but I'm starting to read some stuff on the newspapers websitres obviously that gets under my skin like the one I just blogged about, so I see now why there are so many student and RN bloggers out there.

Hi. I just had a quick look. Seems that they are focusing on management and not nurses as far as I can tell initially.

When a senior manager got caught having sex in the hospital with another employee on cctv at my hospital he was promoted. It was him and two others who were going for the same job. The two others were very good and very supportive of the staff. There were 3 of them and all of their jobs were going to get consolidated into one super position. Sex on tape got the job while the two good ones were made redundant. It was a budgetary thing.

So I wasn't surprised one bit to read that article in the telegraph.

Can you imagine if one of us lowly frontline workers were screwing in the hallway and got caught on ccTV? Promotion? I think not.

My goodness. I read the article and the comments. I am sickened and disheartened by the public's comments. it appears to be open season on nurses in your country. Are there any thinkers among the masses in your country? I am just flabbergasted. I have no other words. You and all the other UK nurses have my condolences, Anne. Casey in the USA

The free thinkers comments were never published. If three nurses on this board who had perfectly reasoned arguments did not get their comments published, how many more nurses, family members of nurses and patients who have an idea of what is going on in the UK didn't get their comments published either?

The daily mail never fails to amaze me with its expert reporting. Casey in the USA, its always open season on nurses over here. The mail and that old hag claire i was a nurse 50 yeas ago so know whats relevant in modern nursing rayner's privately funded patients association relentlessly attack nurses for being slipshod, lazy and uncaring. I am in my final year of training and find it incredibly demoralising to face attacks from the public's comments on stories like this as i see it as an attack on my skills as a nurse.

The findings in this report however once you have removed all the mails raniting shite about nurses are pretty bad. To leave things in the state that is reported is unforgiveable, but if anything highlights issues with how hospitals are rated and inspected. If a trust audits itself its not going to poorly rate itself and end up being financially punished for this is it?

However, if the mail had its way it would make the health service here privatised, to stop all the plebs and immigrants and people who made poor lifestyle decisions unable to receive care. Just read the highest rated comment on that story, blaming the immigrants.

in closing, if by any slim chance anyone from that paper are reading this comment, fuck you daily mail.

I have submitted a comment to this story, however, like ost of my other comments sent to that vile rag I doubt it will be published.

"Such is the standard of "professionalism" - too tired to learn how to do the job properly but not too tired to canoodle." Yes, because we are not allowed personal lives at all are we. Nice story well written Daily Mail. You never tire of attacking nurses and always with such passion. You have the above person aying that we are not professional enough to study in our spare time after woring a 14 hour shift yet say that degree training is irrelevant. Do you have any idea what it is like working on an acute hospital ward these days, its nothing like what Claire Rayner and the private healthcare funded Patients Association would have you think. HCA's are left to deliver personal care because they are not allowed to carry out many tasks that registered nurses have to do. Instead of attacking us why not have a look at the evidence found that the ICN have been reccomending for some time now, we need a minimum nurse to patient ratio enforced by law.

Basically the Daily Mail's comments section (as well as in the BBC's Have Your Say section or even the Guardian's Comment is Free) can be explained by the fact that the loudest, most extreme voices are those that are heard the most online a lot of the time. I don't think the Daily Mail is a representative sample of the British population (I hope not anyway).

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.